The effect of targeted upper cervical musculoskeletal management on the frequency and burden of migraine headache in adults – a single cohort pilot study

OBJECTIVES: The aims of this pilot study were to explore the effects of specific physiotherapy techniques targeted at improving upper cervical rotation in unilateral migraine sufferers with neck pain and asymmetry in upper cervical rotation. This will provide directions for any future modifications for a larger clinical trial. METHODS: A single cohort pilot study using non-randomized participants with unilateral migraine, asymmetrical neck rotation range of motion and palpatory findings at C1/2. Primary outcomes included measures of migraine frequency, cervical flexion rotation test (CFRT) and global perceived effect (GPE) immediately post and 3 months following treatment. Secondary outcome measures were neck disability index (NDI) and headache impact test (HIT-6). RESULTS: Ten female eligible participants were recruited within 10 weeks and completed treatment, with no dropouts or adverse events. At the post-treatment assessment, 9/10 participants had a normalized CFRT, 6/10 had a significant reduced migraine frequency (>50%) and 8/10 were significantly or completely satisfied with treatment on GPE. At 3 months post treatment, 8/10 had a significantly reduced migraine frequency and 5/10 were significantly or completely satisfied with their overall result on GPE. Improvements in one outcome measure, however, did not necessarily align with others, indicating a refinement of these measures may be necessary in future studies. CONCLUSIONS: The pilot study suggests that a subgroup of migraine patients may benefit from this specific physiotherapy approach. The results provide justification for a larger controlled trial, utilizing refined outcome measures and longer-term follow-up. CLINICAL TRIAL REGISTRY NUMBER: ACTRN12625000069459.